Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
  • A61B10/02—Instruments for taking cell samples or for biopsy
  • A61B10/04—Endoscopic instruments
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
  • A61B10/0045—Devices for taking samples of body liquids
  • A61B2010/0061—Alimentary tract secretions, e.g. biliary, gastric, intestinal, pancreatic secretions

Definitions

• the present invention relates to the study of pathological changes in the gastrointestinal system, and more particularly to an apparatus for taking intestinal samples as well as to the use thereof.
• WO 95/32668 discloses a rectal instrument to be used in allergy diagnosis and designed for insertion into the colonic tract to take samples from the lumen of the large intestine after provocation of the mucous membrane with an allergen.
• the instrument comprises a tube-like element having a terminal part that is expandable, specifically an inflatable balloon. Subareas on the balloon have a diffusable allergen absorbed or adsorbed thereto, and on the same or separate subareas, a receptor(s) for one or more inflammation markers, usually antibodies specific to the relevant marker(s), are bound to the balloon.
• the instrument is inserted into the rectum, whereupon the balloon is inflated such that the outer surface of the balloon contacts the mucous membrane.
• the allergen diffuses to the rectal mucous membrane and, if the individual concerned is allergic to the allergen in question, will cause the release of inflammation markers which in turn diffuse to the lumen where they eventually are captured by the receptor(s) on the balloon surface. After the marker or markers have been released and bound to the balloon, the balloon is deflated and the device is removed and analyzed with respect to the bound marker(s).
• the above instrument has, however, the drawback that the areas with diffusible allergen and the areas with immobilized receptor on the balloon surface may be damaged by contact with the internal sphincter when inserted and retracted through the patient's anus. It may also be mentioned, that, generally, immobilizing receptors on the balloon surface could cause problems in that hazardous residues from the coupling of the receptor(s) may remain on the surface.
• the present invention aims at overcoming the disadvantages of the prior art devices or instruments and provide an apparatus for rectal insertion for studying pathological processes in the intestinal mucous membrane without the use of biopsy or perfusion.
• the apparatus of the present invention is based on contacting an expandable part thereof with the intestinal wall for sampling, and optionally also for provocation of the intestine with allergen.
• the sampling area(s) and provocation area(s), when present, of the expandable part essentially are protected from contact with the intestinal wall when the expandable part is inserted and retracted from the colon through the patient's anus.
• the present invention therefore provides an apparatus for taking an intestinal sample in a human or animal patient, comprising a holder part and an expandable part supported by the holder part and having at least one sampling area.
• the expandable part In a non-expanded state of the expandable part, the expandable part is rectally insertable, and in an expanded state, the sampling area or areas of the expandable part are capable of contacting the intestinal wall.
• the apparatus is characterized in that it comprises means for protecting the sampling area or areas from contact with the intestinal wall and intestinal fluid when the expandable part in its non-expanded state is rectally inserted into the intestinal tract.
• the apparatus comprises means for protecting the sampling area or areas also when removing the expandable part from the intestine. While essentially the whole area of the expandable part could be a sampling area, it is preferred that one or preferably, more subareas thereof are used as sampling areas and provocation areas.
• the sampling area or areas on the expandable part may have one or more receptors for, for example, an inflammation or cancer marker or the like bound to the surface thereof (similarly as in the device described in WO 95/32668 above).
• inflammation markers may, for example, be derived from neutrophilic granulocytes, eosinophilic granulocytes, mast cells/basophilic granulocytes, or may be a cytokine, a prostaglandin or a plasma protein, such as albumin.
• the sampling area or areas in this case may have the receptor(s) immobilized directly to the surface of the expandable part, it is preferred that the sampling area or areas comprise a surface element of suitable material attached to the expandable part surface.
• a material may exhibit a two-dimensional surface to which the receptor or receptors are immobilized, or constitute a three-dimensional matrix structure in which the receptor or receptors are immobilized in depth.
• the sampling area or areas comprise absorbing material (without any immobilized receptor) capable of effectively sucking up water and substances dissolved therein (such as proteins, enzymes, hormones etc) when contacted with the intestinal mucosa, such that the content of such substances in the absorbed material may be analyzed.
• a reactant or reactants may be added directly to the absorbing material to detect the presence of a certain substance or substances through a colour reaction or similar.
• the absorbing material is removed from the expandable part after sampling and the absorbed substances extracted and analyzed separately by various analytical methods, such as electrophoresis, radioimmunological techniques, enzyme immunosorbent assay (ELISA) or nephelometry, just to mention a few.
• analytical methods such as electrophoresis, radioimmunological techniques, enzyme immunosorbent assay (ELISA) or nephelometry, just to mention a few.
• the apparatus may be designed for sampling at arbitrary sites along the intestinal tract, it is presently preferred to take samples in the lumen of the large intestine.
• Such sampling may, for example, advantageously be used for testing for markers for allergy, especially food allergy including e.g. celiac disease, after provoking the colonic mucosa with a desired allergen(s), e.g. gluten (as described in the above-mentioned WO 95/32668).
• the expandable part is advantageously an inflatable member of a flexible or elastic material, for example a balloon or an elastic tubular member.
• the sampling area or areas on the expandable part are protected by a protective cover until the expandable part has reached the desired section of the intestine to be studied.
• the cover Prior to or after expanding the expandable part, the cover is removed, e.g. mechanically by pulling means provided on or associated with the apparatus part outside the body, to permit sampling by contacting the sampling area or areas with the intestinal wall.
• the sampling area or areas on the expandable part are protected by a cover which may be opened in connection with the sampling and then be re-closed over the sampling area(s) after the sampling is completed.
• a cover may, for example, be of capsule or shell type, for instance a two-part shell or capsule wherein the two parts together, preferably with some overlap, cover the sampling area(s) in the non-expanded state of the expandable part, but which are removed from and expose the sampling area(s) in the expanded state.
• the expandable part is displaceably mounted (e.g. telescopically) within the holder part of the apparatus so that the expandable part is kept within the holder part during the rectal insertion and retraction of the apparatus, and brought out of the holder part at the test site to be expanded.
• the sampling area or areas on the expandable part are depressed in relation to the remaining surface of the expandable part when the latter is in its non-expanded state to thereby prevent contact with the intestinal wall.
• the expandable part is a balloon or elastic tube or cylinder with sampling elements on the surface
• the holder part supporting the balloon or elastic tube may have a recess or recesses for receiving each sampling element when the balloon is deflated.
• the expandable part may also comprise means for allergen presentation to provoke the intestine before the sampling.
• means for allergen presentation may be the surface itself of the expandable part or a special element(s) having the allergen(s) diffusively bound or adsorbed thereto.
• the allergen-presenting area(s) will, of course, also be protected by the protective means at the same time as the sampling area(s).
• the allergen-presenting area or areas may be the same as the sampling areas.
• Figure 1 A is a schematic perspective and partly sectional view of an embodiment of an apparatus of the present invention with the expandable part of the apparatus in its expanded state and applied in the rectum of a patient.
• Figure IB is a partial view corresponding to that of Fig 1 A but with the expandable part of the apparatus in its non-expanded state before insertion into the rectum of a patient.
• Figure 1C is a partial view corresponding to that in Figure IB but showing the expandable part of the apparatus during insertion into the rectum.
• FIG 2 is a schematic illustration of separate sampling material member on the expandable part of the apparatus shown in Figure 1A.
• Figure 3 A is a schematic partial view in section of another embodiment of apparatus of the invention with the expandable apparatus part protected by protective means.
• Figure 3B is a corresponding view to that in Figure 3 A with the protection means of the expandable part withdrawn.
• Figure 4 is a schematic partial view in section of yet another embodiment of apparatus of the invention in a non-expanded state and showing a sampling surface element protected by being received in a recess in the expandable part.
• the apparatus illustrated in Figs. 1A to 1C comprises a holder part including a tubular member 1, and at one end of the tubular member 1, an expandable part 2.
• the latter is typically a balloon or a balloon-like member, for example made of silicone, and extends over an opening 3 (see Fig. 1A) of a channel (not shown) extending through the tubular member 1 and through which air (or other gas or fluid, if desired) may be supplied via a tube 4 attached to a branched tube part 5 of the tubular member 1 to inflate, or expand, the balloon.
• a through-channel extends from the lower end of tubular member 1 to openings la (Fig. IB) at the top end thereof and for permitting pressure equalization between the surroundings and the internal parts of the intestine when the apparatus is used. In the illustrated case, the through-channel is connected to a tube 6 attached to the tubular member 1.
• the balloon 2 comprises a protective cover of flexible or resilient material.
• the cover is of a two-part capsule or shell type, e.g. of plastics, such as PVC or silicone, comprising a rear (or lower) shell part 7a and a fore (or upper) shell part 7b.
• the fore shell part 7b slightly overlaps the rear shell part 7a such that the two shell parts together totally cover the balloon 2.
• the rear shell part 7a is attached to tubular member 1 at the rear end of the shell part, and fore shell part 7b is attached to tubular member 1 at the fore end of the shell part, leaving the remainder of the two shell parts free from the balloon 2.
• the shell parts 7a, 7b are integral with the balloon 2.
• the surface of the balloon 2 (Fig. 1 A) has, on a central part thereof, a number of pads or patches 8 of absorptive material, e.g. cellulose, attached to the surface thereof, e.g. three or more patches equidistantly spaced along the balloon periphery.
• the patches 7 may be attached directly to the balloon 2, or, via another member attached to the balloon surface such as shown by way of example only in Fig. 2.
• the patch 8 is attached, e.g. by a stitch 9, to a support member 10, e.g. also of cellulose, which in turn is attached to the surface of balloon 2, e.g. by gluing. In this way, the absorptive capability or structure of the patch is essentially unaffected by the attachment to the balloon.
• Inflation and deflation, respectively, of the balloon 2 may be achieved by means of, for example, a syringe or a pumping device, such as a flexible or elastic ball or the like (not shown), connected to tube 4 (Fig. 1 A).
• a syringe or a pumping device such as a flexible or elastic ball or the like (not shown)
• tube 4 Fig. 1 A
• the fore and rear shell parts 7a, 7b are brought apart to expose the area of the balloon 2 supporting the patches 8 as shown in Fig. 1A.
• the material of the shell parts is elastic, the two shell parts may in fact invert as illustrated in Fig. 1 A, to expose a major part of the balloon surface.
• the apparatus described above may readily be inserted through the anus of a patient to be tested.
• the diameter of the balloon is preferably smaller than the diameter of the anus i.e. smaller than about 15-20 mm (but larger than about 5 mm).
• the apparatus is inserted to an appropriate position into the rectum of a patient, with the balloon 2 in the non- inflated state.
• the patches 8 are moistened with water prior to using the apparatus.
• the fore part of the apparatus with the balloon 2 has been inserted into the rectum beyond the internal sphincter, and the balloon has then been inflated to uncover the patches 8 and make them contact the colonic mucosa such as at 11.
• a predetermined time e.g.
• the balloon is deflated.
• the deflation itself may cause the protective shell parts 7a, 7b to return to the patch protecting state shown in Fig. IB where they enclose the patches 8.
• the rear shell part 7a is returned to its protecting state by the forces acting upon the shell part when the balloon is retracted and forced through the anus.
• the patches 8 with absorbed mucous fluid will be efficiently protected by the shell part 7a from further contact with the colonic wall and, importantly, when passing the internal sphincter.
• the absorbing patches 8 which have been in contact with the colonic mucosa are removed from the balloon 2 and the absorbed contents is analysed, e.g.
• the extract may then be analyzed by various methods for different substances, primarily proteins, enzymes or hormones.
• the patches may also be analyzed without extraction by adding directly to the patches, reagents which give a detectable reaction, e.g. a colour reaction, if the substance tested for is present in the pad and may also be a measure of the amount of the substance in question.
• provocation of the intestine may be effected by a desired food allergen (e.g. gluten) contained in the patches 8.
• a desired food allergen e.g. gluten
• the period of contact between the intestinal mucosa and the patches 8 will, of course, be longer, say 15-60 minutes.
• the expandable part comprises a balloon 12 attached to a tubular support 13 which may be a colonoscope or rectoscope, for example, or a device or instrument specially designed for the present purposes.
• a tubular support 13 which may be a colonoscope or rectoscope, for example, or a device or instrument specially designed for the present purposes.
• the balloon 12 is shown inflated in Figs. 3A and 3B.
• a plurality of absorbing elements, such as pads or patches 14 of an absorbing material, are fixed to the balloon surface.
• a protective cover 15 of flexible material is attached to a pulling means 16, e.g. a rod or, as illustrated, a string extending within the tubular support 13. When pulling the string 16, the protective cover 15 is drawn into the interior of the tubular support 13 to expose the absorbing patches 14 on the balloon surface (Fig. 3B).
• the fore part of the illustrated apparatus In use for taking a rectal sample in a patient to be tested, similarly as described above for embodiment in Figs. 1 A to 1C, the fore part of the illustrated apparatus, with the balloon in a deflated state, is inserted into the rectum of the patient to be tested, the cover 15 then efficiently protecting the absorbing patches 14 from contacting the patient's sphincter and the rectal wall.
• the balloon 12 is inflated.
• the cover 15 is then drawn into the tubular support 13 as shown in Fig. 3B, thereby exposing the absorbing patches 14 to make them contact the rectal wall and start absorbing material from the mucous surface thereof.
• the balloon 12 is deflated and the apparatus is removed from the patient.
• the patches 14 are then separated from the balloon and analysed as outlined above.
• Fig. 4 illustrates schematically yet an alternative design of the expandable part of the apparatus, where a tubular support 17 for a balloon 18 has a respective recess 19 for each absorbing patch 20.
• the patch 20 is received in the recess 19 with its top surface below the remaining balloon surface as shown in the figure, and thereby protected from contact with the intestinal wall.
• the balloon When the balloon is inflated, it will expand similarly as shown in, for example, Fig. 1 A, to contact the patch 20 with the intestinal wall.
• the patch 20 is sucked into the recess 19 by the negative pressure created in the deflation and is protected when removing the apparatus from the patient.
• Such recesses for the absorbing patches may, of course, also be used in combination with other apparatus variants of the invention like e.g. those illustrated in Figs. 1A to 1C and Figs. 3 A and 3B, respectively.
• Analysis of the absorbing material may be performed in various ways. A simple procedure is described below by way of example only.
• an extraction buffer e.g. cetyl-N,N,N-trimethylammonium bromide, 0.3% (w/v) in 0.9 % saline.
• the extraction buffer may, for example, be contained in a syringe with the piston removed, e.g. 2 ml of extraction buffer in a 5 ml volume syringe. After a predetermined time, say, 1 hour, the buffer, including absorbed material contained in the patch or patches, is removed.
• the analyte may, for example, be an inflammatory mediator, reflecting neutrophilic activity (e.g.
• EBP eosinophil cationic protein
• EPO eosinophil peroxidase or EPX
• mast cell /basophilic activity histamine or tryptase
• cytokines e.g. IL-6, IL-1, TNF-alfa
• prostaglandins e.g. PGE2

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• Health & Medical Sciences (AREA)
• Surgery (AREA)
• Life Sciences & Earth Sciences (AREA)
• Molecular Biology (AREA)
• General Health & Medical Sciences (AREA)
• Radiology & Medical Imaging (AREA)
• Engineering & Computer Science (AREA)
• Biomedical Technology (AREA)
• Heart & Thoracic Surgery (AREA)
• Medical Informatics (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Animal Behavior & Ethology (AREA)
• Pathology (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Endoscopes (AREA)
• Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
• Investigating Or Analysing Biological Materials (AREA)
• Sampling And Sample Adjustment (AREA)
• Orthopedics, Nursing, And Contraception (AREA)
• Medicines Containing Plant Substances (AREA)

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Cited By (2)

Citations (4)

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• 1999
  • 1999-10-26 SE SE9903872A patent/SE9903872D0/xx unknown
• 2000
  • 2000-10-24 CA CA002387836A patent/CA2387836C/en not_active Expired - Fee Related
  • 2000-10-24 ES ES00973331T patent/ES2304356T3/es not_active Expired - Lifetime
  • 2000-10-24 AT AT00973331T patent/ATE390887T1/de not_active IP Right Cessation
  • 2000-10-24 DE DE60038499T patent/DE60038499T2/de not_active Expired - Lifetime
  • 2000-10-24 AU AU11853/01A patent/AU777463B2/en not_active Ceased
  • 2000-10-24 WO PCT/SE2000/002063 patent/WO2001030243A1/en active IP Right Grant
  • 2000-10-24 JP JP2001532666A patent/JP4810039B2/ja not_active Expired - Fee Related
  • 2000-10-24 EP EP00973331A patent/EP1235519B1/de not_active Expired - Lifetime

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